concussion and cardiac arrest...concussion prevention safe play accurate diagnosis education is...
TRANSCRIPT
Concussion and Cardiac Arrest
Dan Parker MD MPHDavis High School Volunteer Team Physician
Woodland Medical Group
About My Practice
⚫ Specialize in Sports Medicine⚫ Treat Sports Injuries, Fractures, Joint Pain, Tendon and
Muscle Pain⚫ See All Age Groups⚫ Ultrasound-Guided Injections ⚫ Team Physician
⚫ Sacramento Republic FC⚫ UC Davis Intercollegiate Athletics⚫ Davis High School⚫ Woodland High School
Objectives: Concussion and Cardiac Arrest
⚫ Definitions
⚫ Initial Management
⚫ Medical Treatment
⚫ Safe return to sports
What is a Concussion?
⚫ Mild traumatic brain injury (TBI)
⚫ Metabolic, functional (not structural) damage from direct or indirect trauma
⚫ Short Term Deficits
Neurometabolic cascade
Sports Concussion Facts
⚫ Approximately 1.6 – 3.8 million sports concussions occur each year in the U.S.
⚫ 80-90% have no loss of consciousness (LOC)
⚫ 80-90% return to full activity in 7-10 days (NCAA data)
Most Common Sports
Epidemiology of Sports Concussion
⚫ #1 mechanism: hitting heads with another player
⚫ #2 in females: head-to-ball or head-to-ground
⚫ #2 in males: body contact with another player
⚫ Younger and female athletes take longer to recover, high school athletes may need two weeks minimum
⚫We seek to avoid second impact syndrome which is associated with long term issues
Concussion Early Tip Offs
⚫ Headache
⚫ Visual difficulties
⚫ Nausea/vomiting
⚫ Memory loss/confusion
⚫ Balance issues
⚫ LOC: less than 10-20%
Concussion Symptoms⚫ Headache
⚫ Dizziness
⚫ Nausea/vomiting
⚫ Balance issues
⚫ Visual disturbances
⚫ Feeling of fogginess
⚫ Not feeling right
⚫ Confusion
⚫ Light/sound sensitivity
⚫ Difficulty concentrating
⚫ Emotional lability
Does Advanced Imaging Have a Role?
⚫ Excludes severe bleed, critical structural damage
⚫ Does NOT clear an athlete to return to play
⚫ Don’t be fooled:
⚫ Normal imaging does not mean cleared to play
No Same Day “Return To Play”⚫ California AB 25 (2012) for a suspected concussion =
No return to play that day
⚫ Medical clearance by a licensed professional must be given before return to activity
⚫ California AB 2127 (Cooley Law) Jan 1, 2015 =
7 day mandatory no return to play after diagnosis and to follow protocols
Second Impact Syndrome⚫ Getting a second concussion
while still symptomatic
⚫ Generally within the same season
⚫ Mild trauma can have dramatic effect and long recovery
⚫ Major brain injury in sport concussion is almost always associated with second impact
Second Impact Syndrome
First Few Days⚫ No need to keep waking a person up hourly
⚫ Tylenol is ok, no Aspirin or NSAIDs
⚫ If worsening status: go to emergency room
⚫ Consult in 1-2 days with sports medicine
⚫ Rest and cognitive rest
Concussion: Established Treatment
⚫ Cognitive rest
⚫ Limited cell phones, games, texting
⚫ Limited television, no reading
⚫ No physical activity
⚫ Academic accommodations (Return to Learn)*
⚫ www.cdc.gov/concussion
Return to Learn⚫ Important to engage school
administration
⚫ Accommodations include:
⚫ Pre-printed notes
⚫ Recording of lectures
⚫ Quiet room for test taking
⚫ Access to notes during tests
⚫ Additional time for test taking
⚫ Reduced homework
⚫ Individualized instruction
Follow Up Symptoms⚫ Headache
⚫ Visual issues
⚫ Balance
⚫ Sleep
⚫ Irritability
⚫ Lack of Concentration
Steps To Clearance⚫ 1. No symptoms
⚫ 2. Normal focused neurological examination
⚫ 3. Return to baseline or appropriate scores on neurocognitive testing
⚫ 4. Then work with coach, athletic trainer or physical therapist for the progressions to full competition
Computer based NCTNeurocognitive testing
(NCT)
Ideally a baseline test has been done
If no baseline, compare with age related norms: >20th percentile
Impact Test
“Return to Play” Protocol
Rehab progression⚫ Run, jog 20 minutes without symptoms
⚫Wait one day
⚫ Sprint, interval speed work without symptoms
⚫Wait one day
⚫ Return to the field with no contact
⚫Wait one day
⚫ Return to the field with full contact
Concussion Prevention⚫ Safe play
⚫ Accurate diagnosis
⚫ Education is paramount!
⚫ Do not allow an athlete to play with a concussion
All concussions are serious.Don’t hide it, report it. Take time to recover.
It’s better to miss one game than the whole season.
Concussion Take Home Points⚫ No return to play the same day
⚫ Neurocognitive testing (NCT) is becoming the standard of care
⚫ No symptoms, normal exam, normal NCT clears to begin the progression
⚫ Progression: aerobic, sprint, on-field no contact and finally on-field with contact
Fainting and Cardiac Arrest⚫ Every 3 days a youth athlete dies of cardiac sudden death
⚫ Leading cause of death on school campuses
⚫ Sudden cardiac death is 60% more likely to occur during exercise
⚫ 92% of cases are fatal
⚫ With proper emergency treatment life can be saved
Why Do Young Athletes Have Sudden Cardiac Death?
Structural Heart Disease Electrical Abnormalities
Common Warning Signs
⚫ Fainting
⚫ Chest Pain
⚫ Shortness of Breath
⚫ Dizziness
⚫ Fluttering or Racing Heartbeat
CPR Basics
⚫ Check for Pulse⚫ Start Immediately⚫ Compress Chest 2 inches⚫ Count 30 Compressions at a
Rate of 100/minute⚫ Deliver 2 Breaths⚫ Repeat and Do Not Stop
AEDs Save Lives!
⚫ Time is of the Essence
⚫ Call 911
⚫ Start CPR
⚫ Know Where AED Lives
⚫ Turn On, Apply Pads, Shock
Medical Evaluation
⚫ 2016 California Law Mandates Removal from Play for
Fainting or Other Cardiac Symptoms
⚫ Must Be Cleared by Physician, NP, PA Before Return to
Play
How To Reach Me
⚫ Davis High School Students- Contact Andrew Superak ATC
⚫ Regular Clinic Appointment- Office in Davis and Woodland
Call 530-668-2600
2330 W Covell Blvd, Davis
632 W Gibson Rd, Woodland
Resources⚫ McCrory P, Meeuwisse W, Aubry M, et al. Consensus
statement on concussion in sport, Br J of Sports Med 2013; 47:250-258.
⚫ www.cdc.gov/concussion
⚫ www.sacramentovalleyconcussion.com
⚫ Emily's Story of Cardiac Sudden Arrest
⚫ www.aroundthecapitol.com/bills/AB2127
References• Sports-related Head Injury. www.aans.org• www.cdc.gov/concussion• NCAA Sports Medicine Handbook: Sports Related Concussion. www.ncaa.org• www.aroundthecapitol.com/bills• Landre N, Poppe CJ, Davis N, Schmaus B, Hobbs SE. Cognitive functioning and
postconcussive symptoms in trauma patients with and without mild TBI. Arch Clin Neuropsychol. 2006 May;21(4):255-73. Epub 2006 May 22.
• Iverson GL Misdiagnosis of the persistent post concussion syndrome in patients with depression. Arch Clin Neuropsychol. 2006 May;21(4):303-10. Epub 2006 Jun 23.
• Alexander MP. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology. 1995 Jul;45(7):1253-60.
• Bernstein, DM. Recovery from mild head injury. Brain Injury, 1999, 13 (3): 151-172.• Kashluba S, Casey JE, Paniak C. Evaluating the utility of ICD-10 diagnostic criteria for
post concussion syndrome following mild traumatic brain injury. J Int Neuropsychol Soc. 2006 Jan;12(1):111-8.
• Mucha A, Collins MW, Elbin RJ, Furman JM, Troutman-Enseki C, DeWolf RM, Marchetti G, AP Kontos. A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions. Am J Sports Med. 2014 Oct; 42(10): 2479–2486.